Orthodontics

Braces and Invisalign® Teen are both really effective orthodontic treatments. But they can’t always do the job on their own. When a patient has a small or narrow upper jaw, sometimes, an appliance called a rapid palatal expander is needed for skeletal correction, either before or during comprehensive treatment. 

While there are ways to expand an adult’s upper jaw, a rapid palate expander is generally used for kids and teens who are still growing. Since their skeleton is developing and flexible, guiding jaw growth is much easier. 

In this post, the experts at Richard Chan Orthodontics will be sharing everything parents need to know about treatment with an orthodontic expander. 

What is a Rapid Palatal Expander?

A rapid palatal expander (RPE) is a common orthodontic appliance used in phase 1 orthodontic treatment or comprehensive treatment with expansion. Though there are removable palatal expanders, fixed expanders, meaning the appliance stays in place until expansion is complete, are often preferable for younger patients. 

The maxilla (the bone of the upper jaw) is made up of two pieces that don’t fuse together until the mid-teenage years. A palatal expander uses gentle pressure to separate the pieces and widen the palate. 

This can help make room for all of the permanent teeth to fit properly and fixes discrepancies between the upper and lower jaw to create an ideal bite (the way the top and bottom teeth come together). 

How Does an Orthodontic Expander Work?

The device is secured around the back teeth and has two halves that fit against the roof of the mouth. The halves are joined together with a screw at the center. 

You or your child will activate the expander by placing a key in the screw and turning it. Each turn creates tension that exerts gentle pressure on the midline suture, the point where the two maxillary bones meet, and the molars. This pressure pushes the maxillary bones apart and widens the jaw. 

Once your child reaches the prescribed amount of expansion, the appliance will stay in place for several months so new bone can form between the halves of the maxilla, making the expansion permanent. 

As we said above, an expander might be used during early orthodontic treatment before a child has all of their permanent teeth. Normally, however, the expander is used during a comprehensive treatment plan, where the child wears an expander for about six months before we remove it. Immediately after the expansion is completed, orthodontic treatment with braces or Invisalign Teen is used to fine tune the bite and straighten the teeth. 

At Richard Chan Orthodontics, we always treat kids conservatively. And, while there are cases where two phases of treatment are needed, more often than not, we can achieve the same results with a single phase of treatment. Therefore, Dr. Chan may recommend combining an expander with braces. When the goals for expansion are achieved, he’ll take the expander out and your child will continue with braces. 

When is a Rapid Palate Expander Needed?

There are other instances where an expander could be needed, such as certain cases of an underbite, but these are the most common reasons kids and teens require maxillary expansion:

A Crossbite 

A crossbite is when some of the bottom teeth sit outside of the top teeth. A crossbite can be anterior (involving front teeth) or posterior (involving teeth in the back). Often, a posterior crossbite that’s skeletal in nature is due to the upper jaw being too narrow in relation to the lower jaw. 

When that’s the case, expansion could be the best course of action. If not treated, patients with a posterior crossbite can compensate by shifting their jaw to the side, causing permanent changes in their facial structure. Crossbites can also result in jaw and TMJ pain and worn teeth. 

Airway Issues

Breathing through the nose helps the lungs absorb oxygen, filters out impurities, adds moisture to the air, and even plays an essential role in kids’ growth. When nasal breathing isn’t possible and kids resort to mouth breathing, it has a negative impact on the development of their jaw and facial structures and can lead to sleep-disordered breathing, which includes obstructive sleep apnea. 

Upper expansion widens the nasal floor (the palate is the floor of the nose), makes more room for the tongue and permanent teeth, and helps open the airway. This can enable kids to breathe easier, prevent or reduce sleep-disordered breathing and the associated side effects, and stop mouth breathing from impacting their appearance and health as an adult. 

Severe Crowding

Crowding occurs when the jaw is too small to fit all of the permanent teeth. Teeth might twist, overlap, or even become impacted (stuck beneath the bone). Crowded, crooked teeth are harder to clean, which increases the risk of tooth decay and gum disease. Crowding can also cause uneven wear and interfere with function. 

By widening the upper jaw with an expander, the teeth will have enough space and extractions can be avoided. Expansion may also create room for impacted teeth (commonly the canine teeth) to erupt without needing oral surgical procedures or extractions.

How Long Does Expansion Take?

The actual expansion only takes a few weeks. But the expander needs to stay in place for a while longer to give new bone time to form in the space between the maxillary bones. This is what stabilizes the expansion. On average, patients wear an expander for about six months. 

Does a Rapid Palatal Expander Hurt?

We know, the idea of palate expansion does seem a little intense. But, because the maxillary bones in kids and teens aren’t fused together, manipulating them isn’t painful and only a small amount of tension is needed to shift them apart. 

That said, while your child won’t feel severe pain from a rapid palatal expander, they may have mild soreness and pressure after turning the key, particularly during the first several days. 

To keep them comfortable, have them stick with a liquid diet (soup, smoothies, etc.) for the first day and then soft foods for a couple of days to a week. It’s also a good idea to activate the expander at night, so by the time your child wakes up, most of the pressure is gone. 

Are There Other Side Effects From an Expander?

Chewing and speaking can feel weird at first. Within a few days, your child or teen will get used to having the expander in their mouth and their ability to chew and speak will return to normal. 

If you notice a space forming between your child’s front teeth, have no fear! This is completely normal and a sign that the expander is working and their jaw is widening. We’ll close the gap with braces or Invisalign.

How to Adjust an Expander

Dr. Chan will show you and your child how to adjust an expander. Sometimes it can take doing it yourself a few times to feel confident, but, we promise, it’s simple. Here’s how to activate the expander:

• Tip the head back. 
• Have someone help shine a light into the mouth so you can see better.
• Put the key Dr. Chan gave you into the hole at the front center of the appliance.
• Push the key toward the back of the mouth until it stops and you can see the next hole.
• Carefully remove the key from the mouth. You should be able to clearly see the new hole for the next turn.

Depending on your child’s age, Dr. Chan may recommend either two turns per day (usually for older children/teenagers), or one turn every other day (usually for younger children). He will inform you how often and how many turns total. 

What Happens if You Turn an Expander Too Much?

Patients are sometimes curious about what happens if you turn your expander too much. Turning the expander more than prescribed will compromise the results and cause more discomfort. It will not speed up treatment. 

What if My Child Forgets to Activate Their Expander?

If your child forgets to activate their expander, do not do two turns the next time. Keep going with one turn per time, and add the missed turn to the end. While missing one turn isn’t a huge deal, be sure to keep in mind that adjusting the expander according to Dr. Chan’s directions will keep your child’s treatment plan on schedule. 

How to Take Care of an Expander

Orthodontic appliances give food debris and plaque more places to hide. So, when wearing an expander, have your child or teen brush their teeth in the morning, after meals and snacks, and before bed. They should continue flossing once daily too. 

Kids will want to gently brush their expander, including the screw and bars, when they brush their teeth. If they’re at school or out somewhere and forget their toothbrush, they can swish with water to keep the appliance clean until they can brush again. 

As for eating with an expander, the food restrictions are similar to those kids have with braces. Avoid anything really hard, chewy, or sticky like whole, raw apples, caramels, hard pizza crust, gum, and licorice.

What are the Benefits of Expansion?

When a rapid palatal expander is necessary, the benefits are significant. Expansion can:

• Help kids and teens avoid the need for corrective jaw surgery
• Prevent the need for tooth extractions
• Open the airway and encourage nasal breathing 
• Guide growth to correct a crossbite, crowding, and other skeletal concerns
• Create a wider, more aesthetically pleasing smile
• Make room for impacted teeth to erupt on their own

Schedule a complimentary consultation at Richard Chan Orthodontics in Bothell, Monroe, and Mill Creek, WA or Juneau, AK to get personalized treatment recommendations for your child or teenager. If a rapid palate expander is needed, Dr. Chan will walk you through his diagnosis, the process, and what to expect, so you feel fully informed about your child’s smile journey.

If your third molars, or wisdom teeth, are impacted or causing complications, having them extracted can benefit your oral health. But, as you probably know, wisdom tooth removal is a type of oral surgery and, of course, there will be a healing period after the procedure.

During your recovery, you’ll avoid brushing around the extraction sites, vigorous swishing and spitting, using a straw, and eating hard foods, among other things.

But what about putting in your removable retainer? If you have one, you might be asking, “When can I wear my retainer after wisdom tooth removal?” Our Juneau, AK and Bothell, Monroe and Mill Creek, WA orthodontist Dr. Richard Chan has answers!

When Can I Wear My Retainer After Getting My Wisdom Teeth Taken Out?

Since you’re concerned about when you can wear your retainer after wisdom tooth removal, we’re guessing that means you know just how important the appliance is. And, it’s true, wearing an orthodontic retainer after braces or Invisalign® treatment is the only way to maintain your results. 

But, proper healing and managing pain and swelling are the main priorities after having your wisdom teeth removed. If your oral surgeon’s after-care instructions mention when you can wear your retainer again, follow those guidelines. 

Otherwise, wait a full 24 hours after surgery before attempting to put in your retainer. You don’t want to inadvertently irritate the extraction sites or dislodge clots. After 24 hours, you can try your retainer whenever you feel ready. If it’s comfortable and doesn’t cause any pain, you’re good to go! Just be sure to keep it clean, so you’re not introducing any extra bacteria into your mouth. 

Most people feel back to normal within three days to a week after wisdom tooth removal, depending on the complexity of their case. So, even if your first attempt at wearing your retainer is uncomfortable, it’s very likely you won’t have to wait too long before you feel well enough to try again. 

Will My Retainer Still Fit After Wisdom Tooth Removal?

Generally, yes! The majority of patients finish braces or Invisalign treatment before their wisdom teeth erupt, which usually happens between the ages of 17 and 21.

If you were one of our teenage Juneau, Bothell, Monroe or Mill Creek braces or Invisalign patients, we probably created a custom, 3D-printed, clear plastic retainer for you to wear when you finished treatment. The retainer was designed to fit your pre-wisdom teeth smile. 

As we said in our blog post on wisdom teeth and braces, when the wisdom teeth come in, they don’t exert enough pressure to shift nearby teeth. So, these molars erupting or being removed won’t change the way your clear retainer fits. 

While it will depend on the design of your specific retainer, the same usually holds true for Hawley retainers. These retainers, which have an acrylic base with a wire that wraps around the front of the teeth, are also designed for when you finish braces or Invisalign treatment, which usually occurs before you get your wisdom teeth. 

If you had your wisdom teeth when you underwent orthodontic treatment and the retainer you received fits over them, then you may need to have your retainer adjusted or a new one created to fit your smile once your wisdom teeth are gone. 

How Long Do You Have to Wear a Retainer?

Getting your wisdom teeth removed isn’t a sign you can stop wearing your retainer. While you’ll use your retainer most frequently in the months after finishing orthodontic treatment to lock in your results, your teeth can still shift even years later if you forgo it.

So, how long do you have to wear a retainer? Ideally, for life. The good news is, you’ll reach a point where you only need to wear it a few nights per week. If that’s the stage you’re at when you get your wisdom teeth taken out, you’ll have a little more wiggle room.

Otherwise, if you skip wearing your retainer for too long after wisdom tooth removal (or at any time!), your teeth will shift and your retainer will feel tight. Eventually, your retainer won’t fit at all. While you can get a new one, it will hold your teeth where they are. To move your teeth back to their post-treatment positions, you’ll need braces or Invisalign again. How Long Do You Have to Wear a Retainer?

Richard Chan Orthodontics Has Your Smile Covered

Have more questions about when you can wear your retainer after wisdom tooth removal? Reach out and we’ll be happy to help. 

If you need a new retainer or you’d like to touch-up your smile after forgetting to wear it, schedule a complimentary consultation at Richard Chan Orthodontics in Bothell, Monroe or Mill Creek, WA or Juneau, AK. 

There’s always that one friend or family member with perfectly straight teeth who never needed braces or Invisalign. It can make you wonder how that’s possible and what’s behind your own misaligned teeth or jaw.

Are crooked teeth genetic? Why do some people have crooked teeth while others don’t? Can misalignment be prevented? In this post, our Bothell, Monroe, Mill Creek, Everett and Juneau orthodontist will be diving into 8 common causes of crooked teeth and what you can do about it.

Are Crooked Teeth in Kids Always a Concern?

Before we cover the causes of crooked teeth, let’s talk about primary teeth. Parents sometimes panic when their child’s teeth aren’t straight, but crooked teeth in kids are not always indicative of a problem.

If your kiddo has crooked baby teeth, they won’t necessarily have crooked permanent teeth. This is especially true for spacing. Spaces or gaps between baby teeth can be a good thing since the permanent teeth are larger and will take up more room once they erupt. For this same reason, however, if your child has significantly crowded baby teeth, there is a chance that the permanent teeth will be crowded too.

The American Association of Orthodontists recommends children have their first orthodontic evaluation by age 7. This might sound really young, but it’s for a good reason. At this age, Dr. Chan can see how your child’s bite is shaping up. We always treat kids conservatively at our practice and most won’t need treatment right away. They’ll simply come in occasionally over the years, so we can pinpoint the ideal time for them to start braces or Invisalign when they’re teenagers.

However, if Dr. Chan does identify red flags like abnormalities with jaw or facial growth or severe crowding, sometimes, intervening early will bring about the best results. In certain cases, he may recommend phase 1 orthodontic treatment, which is when we use orthodontic appliances to guide jaw and facial growth (dentofacial orthopedics) while a child is still developing.

The goal is to correct any skeletal abnormalities and make room for the permanent teeth to come in correctly. When early orthodontic treatment is necessary, it can make later treatment easier and prevent the need for corrective jaw surgery or the extraction of permanent teeth.

Other times, if we identify myofunctional or oral habits (i.e., thumb sucking, tongue thrust, mouth breathing, etc.), which we’ll talk about shortly, we can give parents guidance on correcting the habit. Stopping the habit might not prevent crooked teeth entirely, but it may ward off more serious malocclusion (improper bite) that would require extensive treatment.

What Causes Crooked Teeth?

So, what causes crooked teeth? Here are 8 common culprits:

1. Genetics
   For a lot of patients, crooked teeth are genetic. If one or both of your parents have crooked teeth, you could also have crooked teeth. The different types of malocclusion, such as an overbite, underbite, open bite and crossbite, while sometimes caused or worsened by oral habits, are often due to the size or position of the jaw. The size of our jaws and teeth are determined by genetics, but they often do not match each other. For example, we might get a smaller jaw from one side of the family, and then larger teeth from the other side, resulting in excess crowding. Or, if the opposite happens, and we get larger jaws with smaller teeth, then we will have excess spacing.
2. Oral Habits
   Repetitive oral habits like thumb sucking or prolonged pacifier use, especially if the habit continues once the permanent teeth start to erupt, can also be a cause of crooked teeth and a misaligned bite. As a child sucks on their thumb or pacifier, they exert pressure behind the top front teeth. This pressure can cause changes in their palate, as well as lead to protruding or overjet teeth and issues like an open bite.
3. Orofacial Myofunctional Disorders
   Orofacial (mouth and face) myofunctional (muscle function) disorders, such as mouth breathing and tongue posturing, are also common causes of crooked teeth. When kids have trouble breathing through their nose, whether due to an airway problem or even allergies, they may resort to mouth breathing. Chronic mouth breathing, in turn, can cause problems with their facial development, leading to crooked teeth and all types of malocclusion.
   Tongue thrust, also called reverse swallowing or immature swallowing, is when the tongue hits against or protrudes in between the front teeth when a person swallows or talks. Although the thrusting movement is not enough to cause crooked teeth, the tongue will usually stay in a forward position when at rest too, which does cause problems. Inside of the mouth, the tongue puts pressure against the teeth while, from the outside, the facial muscles exert pressure. The combination can interfere with craniofacial development and cause crooked teeth and bite issues.
4. The Early Loss of Primary Teeth
   The primary teeth, or baby teeth, are important. It can seem like no big deal if a child loses a baby tooth early since it would have fallen out anyway, but that’s not the case. The baby teeth help with facial and speech development, aid in chewing and, most importantly, save space for the permanent teeth to come in. When a baby tooth is lost before it’s supposed to fall out, and a space maintainer isn’t placed, the remaining teeth will shift into the gap. The permanent tooth won’t be able to erupt correctly and, in extreme cases, can even become impacted (stuck under the tissue or bone), leading to crowding.
5. Trauma
   Sustaining a dental injury like an elbow to the mouth while playing sports can displace the teeth. If not treated, not only can the one tooth become crooked, but the other teeth may shift to accommodate the damaged tooth.
6. Not Replacing Missing Permanent Teeth
   If you lose a permanent tooth from periodontal disease, severe decay, an injury or a health condition, it’s essential to replace it with a dental implant or a restoration like a dental bridge. This is because, just like we talked about with a missing baby tooth, when you have a missing permanent tooth that isn’t replaced, the remaining teeth will shift into the space left behind. This will create changes in your bite and can ultimately cause crooked teeth.
   Additionally, since the jawbone isn’t being stimulated anymore where the tooth is missing, the body will resorb the bone. This bone loss might also impact the alignment of your teeth and even the appearance of your face.
7. Natural Changes With Age
   As we get older, the bite often deepens and the teeth tend to shift naturally. This is why wearing a retainer after braces or Invisalign is the key to maintaining your results. If you forget to wear your retainer, over time, you will experience a relapse. Even if you didn’t need braces or Invisalign before, you might find that your teeth become crooked as you get older.
8. Dental Work
   Improperly fitting dental restorations like crowns, bridges and fillings can have a negative impact on your bite, causing pain and reduced function, as well as misaligned teeth.

Can Crooked Teeth be Prevented?

There’s no way to guarantee that you’ll have straight teeth and won’t need braces or Invisalign. Crooked teeth and a misaligned bite often have a genetic component and, if that’s the case, they can’t really be prevented.

That said, stopping oral habits such as thumb sucking and pacifier use and seeking out treatment for issues like tongue thrust/posture and mouth breathing, can prevent some bite issues or, at least, ensure they don’t continue to get worse.

Crowding can also be reduced or, sometimes, prevented, by opting for a dental space maintainer for a baby tooth that’s lost too early or by replacing a missing permanent tooth. Lastly, wearing a mouthguard when playing sports or doing any activity that could result in a blow to the face is good practice and will keep your teeth safe and where you want them.

Why Do Crooked Teeth Need to be Fixed?

There are times when slightly crooked teeth or a small gap can add charm to your smile and might not need to be corrected unless you feel self-conscious. But, the truth is, often, crooked teeth should be fixed because:

• Most importantly, you want a beautiful smile, and your crooked teeth bother you.
• Some of the teeth will bear more of the brunt when you chew, resulting in excessive or uneven wear of the enamel.
• They can make chewing difficult or painful when they are in certain wrong positions.

How to Fix Crooked Teeth

We talked about the causes of crooked teeth, whether they’re a concern in kids and why they should be fixed. Now, let’s go over how to fix crooked teeth. The first step is visiting Richard Chan Orthodontics for a complimentary consultation.

We’ll take any necessary diagnostic records, like photos and digital x-rays, and Dr. Chan will complete a thorough examination. He’ll use his findings to develop an accurate diagnosis and personalized treatment recommendations.

Treatment options could include:

• Metal BracesMetal braces are the original way to fix crooked teeth and they’re still around today, because they’re effective. Modern metal braces are smaller and more streamlined than those of the past. They’re an excellent treatment option for kids, teens and adults, including those with severe orthodontic issues. They tend to be super popular with our younger patients who love getting to personalize their braces with colorful elastics. We have the common silver metal braces, and we also have gold braces for those who prefer them!
• Clear BracesClear braces, or ceramic braces, work in the same way as metal braces. However, the brackets are crafted from a durable ceramic material that blends in with your smile. They’re much less noticeable than their metal counterparts. Many of our adult braces patients prefer clear braces.
• Invisalign or Invisalign TeenIf you’re wondering how to fix crooked teeth without braces, Invisalign could be the solution. The system of clear, removable aligners is a convenient, comfortable treatment option. Dr. Chan designs your ideal smile on a virtual, 3D model of your mouth and the aligners are custom-made for you based on his specifications. As you make your way through your aligners, your smile will gradually take shape. The aligners are virtually invisible and since they’re removable, there are no food restrictions and oral hygiene is simple.Invisalign Teen works in the same way as Invisalign for adults. However, the aligners are designed especially for younger patients with features including eruption tabs to accommodate erupting teeth and free replacement aligners included in the system.

Connect with Dr. Richard Chan Today!

If you’re concerned about crooked teeth and you’re ready to find out which treatment option will bring out the best in your smile, we can help. Schedule a complimentary consultation at our Bothell, Monroe or Mill Creek, WA or Juneau, AK orthodontic offices to get started.